* ASSISSTIVE DEVICES

* Assistive devices are external devices that are

designed, made, or adapted to assist a person
to perform a particular task
* People with disabilities depend on assistive
devices to enable them to carry out daily
activities and participate actively and
productively in community life.

*Introduction
* To promote the availability of appropriate
devices and mobility aids and provide
accessible information about them
* The Standard Rules on the Equalization of
Opportunities for Persons with Disabilities also
call upon States to support the development,
production, distribution and servicing of
assistive devices and equipment and the
dissemination of knowledge about them

* The Convention on the Rights

of Persons with Disabilities,
Articles 4, 20 and 26,
* In many low-income and middle-income
countries, only 5–15% of people who require
assistive devices and technologies have access
to them
* Production is low
* Limited quality,
* Very few trained personnel and costs may be
prohibitive.

*ISSUES IN
PROVISION OF
ASSISSTIVE DEVICES
* Access to assistive devices is essential for many
people with disabilities and is an important
part of any development strategy. Without
assistive devices, people with disabilities may
never be educated or able to work, so the
cycle of poverty continues. Increasingly, the
benefits of assistive devices are also being
recognized for older people as a health
promotion and prevention strategy

*IMPORTANCE OF AD
* Community Based Rehabilitation Biratnagar
(CBRB) is a nongovernmental organization that
has been working in the eastern region of
Nepal since 1990
* In 1997, CBRB started a small orthopaedic
workshop to carry out minor repairs of assistive
devices, as many people with disabilities had
to travel to the capital or neighbouring India
for repairs.

*Being able to work

again- Example
* CBRB worked towards establishing a fully
equipped orthopaedic workshop. Working in
partnership with Handicap International (Nepal)
they developed a comprehensive service which
included the fabrication, provision and repair of
assistive devices
* Local people (women and men, with and
without disabilities) were trained as technicians
in Nepal and India and integrated into the
existing CBRB team

*CONT’D
* CBRB now provides quality orthoses (e.g.
calipers, braces, splints), prostheses (e.g.
artificial legs and hands) and mobility devices
(e.g. crutches, tricycles, wheelchairs) to
people living with disabilities in 16 districts of
eastern Nepal
* CBR personnel, therapists and workshop
technicians all work hand-in-hand to enhance
the quality of life of people with disabilities.

*CONT’D
* One of the people to have benefited from the
orthopaedic workshop is Chandeswar
* He is a rickshaw-puller who worked hard until
he suffered an injury and had his left leg
amputated.
* He lost his income because he was no longer
able to work as a rickshaw-puller and he lost
his savings because he needed to pay for his
medical care.

*CONT’D
* Chandeswar was identified by the CBRB team
working in his village, who fitted him with a
below-knee prosthesis and provided
rehabilitation to ensure he was able to walk
well with his artificial leg and learn how to
pedal his rickshaw again. Now Chandeswar is
back pedalling his rickshaw around the busy
streets of Biratnagar and making a reasonable
living.

*Cont’d
* People with disabilities have access to
appropriate assistive devices that are of good
quality and enable them to participate in life
at home and work and in the community.

*Goal
* The role of CBR is to work with people with
disabilities and their families to determine
their needs for assistive devices, facilitate
access to assistive devices and ensure
maintenance, repair and replacement when
necessary.

*The role of CBR

* CBR personnel are knowledgeable about
assistive devices, including the types available,
their functionality and suitability for different
disabilities, basic fabrication, availability within
communities and referral mechanisms for
specialized devices.
* People with disabilities and their families are
knowledgeable about assistive devices and make
informed decisions to access and use them.

*Desirable outcomes
* People with disabilities and their families are
provided with training, education and follow-
up to ensure they use and care for their
assistive devices appropriately.
* Local people, including people with disabilities
and their families, are able to fabricate basic
assistive devices and undertake simple repairs
and maintenance.

*Desirable outcomes
* Barriers preventing access to assistive devices,
such as inadequate information, financial
constraints and centralized service provision,
are reduced.
* Environmental factors are addressed to enable
individuals to use their assistive devices in all
locations where they are needed.

*Desirable outcomes
* Assistive devices range from simple, low-
technology devices (e.g. walking sticks or
adapted cups), to complex, high-technology
devices (e.g. specialized computer
software/hardware or motorized wheelchairs).
It is helpful to consider this wide variety of
assistive devices under different categories

*Common types of
assistive device
Mobility devices assist people to walk or move
and may include:
* wheelchairs
* tricycles
* crutches
* walking sticks/canes
* walking frames/walkers.

*Mobility devices
* People with physical impairments often have
difficulty maintaining good lying, standing or
sitting positions for functional activities and
are at risk of developing deformities due to
improper positioning. The following devices
can help overcome some of these difficulties:
* wedges
* chairs, e.g. corner chairs, special seats
* standing frames.

*Positioning devices
* These are usually custom-made devices which
replace, support or correct body parts. They
are designed, manufactured and fitted in
specialized workshops or centres by trained
prosthetic/orthotics personnel and include:
* prostheses, e.g. artificial legs or hands
* orthoses, e.g. spinal braces, hand/leg splints or
callipers
* orthopaedic shoes.

*Prosthetics, orthotics
and orthopaedic
shoes
*These devices enable people with disabilities to
complete the activities of daily living (e.g. eating,
bathing, dressing, toileting, home maintenance).
There are many examples of these devices, including:
*adapted cutlery and cups
*shower seats and stools
*toilet seats and frames
*commodes
*dressing sticks.

*Daily living devices

* Low vision or blindness has a great impact on a person's ability to
carry out important life activities. A range of devices (simple to
complex) can be used to maximize participation and
independence, including:
* large print books
* magnifiers
* eyeglasses/spectacles
* white canes
* braille systems for reading and writing
* audio devices, e.g. radios, talking books, mobile phones
* screen readers for computers, e.g. JAWS (Job Access with Speech)
is a screen reader programme.

*Vision devices
* Hearing loss affects a person's ability to communicate and
interact with others; it can impact on many areas of
development, e.g. speech and language and restricts
educational and employment opportunities, resulting in
social discrimination and isolation. Devices include:
* hearing aids
* headphones for listening to the television
* amplified telephones
* TTY/TTD (telecommunication devices)
* visual systems to provide cues, e.g. a light when the
doorbell is ringing.

*Hearing devices
* Augmentative and alternative communication devices
can assist individuals who have difficulty understanding
and producing speech. They are provided to support
speech (augmentative), or to compensate for speech
(alternative). Devices include:
* communication boards with pictures, symbols or letters
of the alphabet
* request cards
* electronic speech output devices
* computers with specialized equipment and programmes.

*Communication
devices
* Cognition is the ability to understand and process information. It
refers to the mental functions of the brain such as memory,
planning and problem-solving. Brain injuries, intellectual
impairment, dementia and mental illness are some of the many
conditions that may affect an individual's cognitive ability. The
following devices can assist individuals to remember important
tasks/events, manage their time and prepare for activities:
* lists
* diaries
* calendars
* schedules
* electronic devices, e.g. mobile phones, pagers, personal organizers.

*Cognitive devices
* Appropriate technology
* Appropriate technology meets people's needs;
it uses local skills, tools and materials and is
simple, effective, affordable and acceptable to
its users. Assistive devices are technologies
that must be carefully designed, produced and
selected to ensure they meet these criteria.

*Selection of assistive
devices
* The Assisi Leprosy and CBR programme in Andhra Pradesh, India
provided sandals made of black microcellular rubber to people
with leprosy who had lost sensation in their feet and were at risk
of foot ulcers. It became obvious that many people who were
provided with these sandals did not use them. After talking with
these people, it was discovered that by wearing the sandals they
were subject to social stigma – the black sandals had become
easily identifiable in the community as shoes that only people
with leprosy wore. As a result the programme decided to use
sandals available from the local market, modifying them as
necessary to suit the requirements of people with leprosy. People
began wearing the footwear as there was little visible difference
between their sandals and those that other community members
wore

*Example- Wearing
the same shoes
* Assistive devices need to be carefully selected and often
specially made and fitted to ensure they meet the
individual's needs. Poor selection and design can lead to
many problems including frustration, discomfort and the
development of secondary conditions. 
*  For example, it may be common practice in some
countries to distribute donated or second-hand
wheelchairs on a large scale. While this may have
benefits, it also has the potential to cause harm to users,
e.g. the provision of a wheelchair without a cushion to a
person with a spinal cord injury may cause a potentially
life-threatening pressure area

*Assessment
* Comprehensive assessment is necessary to ensure assistive
devices meet the needs of individuals within their homes,
schools and work and community environments.
* A comprehensive assessment might include a medical
history, a review of current function, individual goals, an
evaluation of existing assistive devices and a physical
examination.
* The approach to assessment should be multidisciplinary
where possible and include a wide variety of people, such
as people with disabilities, family members, therapists,
technicians, teachers and CBR personnel.

*Cont’d
* Barrier-free environments
* Adaptations/modifications to the physical environment
include installing a ramp where there are steps,
widening a narrow doorway, reorganizing furniture to
increase the amount of space for movement. It is also
important to consider other aspects of the environment.
* For example, a young boy who uses a communication
board instead of speech will need to use his board both
at home and at school, so it is important that family
members, schoolteachers and friends are positive,
willing and able to use this device with him.

*Use of assistive
devices
* When considering environmental modifications,
particularly within the community, it is helpful
to consider “universal design”. Universal design
means designing products, environments,
programmes and services to be usable by all
people, both with and without disabilities.

*Modifying
environment
*Suggested activities
* CBR personnel require training on assistive devices to
ensure that they are able to provide accurate information,
referral and education. Training may be specific, or it may
be part of a course on rehabilitation. CBR personnel need
knowledge about:
* the common types of assistive device;
* the purpose and function of assistive devices;
* which basic devices can be prepared in the community, e.g.
crutches;
* where specialized devices, e.g. prostheses and hearing aids,
are available;
* referral mechanisms, to enable access to specialized devices;
* the funding options available for people who are unable to
afford devices.

*Train CBR personnel

* Practical training is also essential, particularly for CBR personnel
who work in rural/remote areas, to ensure they can produce basic
assistive devices and develop the skills and confidence to work
directly with individuals who need the devices. For example, CBR
personnel may need to:
* show a family how to build a wooden chair with a strap to enable a
child with poor balance to sit upright;
* show a family how to build parallel bars to enable walking practice at
home;
* show a family how to make a simple walking stick for a person
recovering from a stroke to assist her/him in walking;
* teach a child with cerebral palsy, with no speech or coordinated hand
movement, how to use a pictorial communication board using her/his
eyes;
* provide instruction to a blind person on the use of her/his white cane.

*Training CBR
personnel
* CBR personnel need to work closely with people with disabilities and
their family members to ensure that they are:
* aware of the different types of assistive device and how these can
assist individuals to achieve independence and participation;
* involved in decision-making regarding the selection and design of
assistive devices – providing opportunities for people to see and try
assistive devices will assist them to make informed decisions;
* able to use their assistive devices properly and safely and are able
to perform repairs and maintenance to ensure long-term use;
* able to give feedback to referral services about any difficulties
experienced so that adjustments can be made and different options
considered.

*Build capacity of
individuals and families
* Local artisans can be trained to make small repairs to
assistive devices such as orthoses, prostheses and
wheelchairs, e.g. repair orthoses by replacing straps, screws
or rivets. CBR programmes can identify local artisans and
facilitate this training in partnership with technicians.
* Assistive devices such as walking sticks, crutches, walking
frames, standing frames and basic seating can also be
produced by local artisans because they are simple to make
using locally available materials. CBR programmes can
identify local artisans who are interested in producing them
and facilitate training.

*Train local artisans

* In 2000, the National CBR programme in
Mongolia organized a training course for staff
working at the National Orthopaedic Laboratory
in Ulaan Baatar, to teach them how to make
simple splints, seating devices and mobility
devices using local materials and appropriate
technology. Now, whenever a CBR programme
starts in a new province of Mongolia, two local
artisans are identified and trained at the
National Orthopaedic Laboratory.

*Learning how to
make assistive
devices
* Access to assistive devices may be limited by
inadequate information, poverty, distance and
centralized service provision. CBR personnel
need to work closely with people with
disabilities and their families to facilitate
access to assistive devices by:

*Facilitate access to
assistive devices
* identifying existing service providers – local, regional
and national – who produce and/or supply a wide range
of assistive devices (basic and specialized);
* compiling detailed information on each service
provider, including referral mechanisms, costs and
processes, e.g. administrative procedures, assessment
procedures, number of visits required for measurements
and fittings and time for production;
* ensuring this information is available in an appropriate
format and is communicated to people with disabilities
and their families

*Facilitate access to
assistive devices
* identifying funding options for people who are unable to
afford the costs associated with assistive devices – CBR
programmes can facilitate access to existing government or
nongovernmental schemes and can raise their own funds
and/or empower individual communities to donate
resources;
* assisting people to complete relevant administration
processes so they can obtain a disability certificate, which
in many countries will enable them to access free devices;
* partnering with referral centres, local authorities and other
organizations to discuss ways to decentralize service
provision, e.g. mobile facilities;

*Facilitate access to
assistive devices
* providing transport for small groups of people
from rural/remote areas to travel to referral
centres, ensuring prior arrangements are made
with these centres.
* providing home or community-based repair
services for people living in rural/remote
areas, e.g. establish a mobile service or regular
meeting point in the community for people
needing repairs to their devices.

*Facilitate access to
assistive devices
* When referral services are not available, or barriers such as
cost and distance cannot be overcome, CBR programmes can
consider setting up and/or supporting a small workshop to meet
local needs. Simple devices can be produced by locally trained
people
*  Both the WHO CBR manual and Disabled village children
provide information about making assistive devices in the
community using local resources.
* People with disabilities can also be trained to make assistive
devices. This can generate income and lead to their recognition
as active contributors to their communities, to the development
of social networks and ultimately to empowerment.

*Set up small-scale
workshops
* In some countries it may not be feasible to establish services that
provide a wide range of assistive devices. This may be due to
government priorities, limited resources, or small populations. But
many assistive devices will be available in neighbouring countries,
where they are likely to be cheaper and easier to access than
importing them from high-income countries.
* CBR programmes need to determine what resources are available in
neighbouring countries and collaborate with these countries where
possible. In addition, CBR programmes need to develop strong links
with international and national nongovernmental organizations who
are often active in producing and providing assistive devices with a
view to the development of sustainable service provision.

*Network and
collaborate
* Very often there are barriers in the home,
school, work or community environments that
make it difficult for people to use their
assistive devices. CBR personnel require
practical knowledge regarding these barriers so
they can work with individuals, family
members, communities and local authorities to
identify and address them.

*Address barriers in
the environment
* Assistive aids- external devices- aid in activity
* Issues in assistive aids
* Importance of Assistive aids
* Role of CBR
* Types of Assistive devices and selection
* Assessment
* Provision
* Suggested activities to provide assistive aids
effeciently

*Summary
*Thank you.